Sepsis

Front 1

sirs clinical presentation

Back 1

- 2 or more
- temp: >38 (100.4) or <36 (96.8)
- hr >90
-rr >20
-wbc>12,000 or <4000, or bands >10%

Front 2

def dic

Back 2

- intravascular deposition of fibrin
- depletion of platelets

Front 3

dx of dic

Back 3

- thrombocytopenia <100, 000
- prolongation of clotting time
- increase fibrin-degradation
- depleted anticoag
- dec fibrinogen

Front 4

normal urine output

Back 4

0.5-1 cc/kg/hr

Front 5

bp equation

Back 5

bp= co x svr

Front 6

co equation

Back 6

co= hr x sv

Front 7

svr equation

Back 7

svr= 80 x map-cvp/co

Front 8

map equation

Back 8

1/3sbp + 2/3dbp

Front 9

hemodynamic instability is defined as

Back 9

- dec in sbp < 40%
- sbp <90
-map <70

Front 10

sepsis map value is

Back 10

<70

Front 11

normal cvp is

Back 11

2-6 mmHG

Front 12

resus goals should be achieved w/ in

Back 12

6hrs

Front 13

resusitation goals

Back 13

1) cvp 8-12, mechanically vent 12-15
2) map >65
3) uop 0.5 ml/kg/hr
4) central venous oxygen saturation >70%

Front 14

ae ns

Back 14

- hypernatremia
-dilutional coagulopathy
- hyperchloremic non ion gap acidosis
- fluid overload

Front 15

ae lactate ringer

Back 15

- fluid overloaded
-alkilosis ( avoid in liver pts)
- hyponatremia
-hyperkalemia

Front 16

ns vs lactate ringer

Back 16

- na: hyper- ns, hypo- lr
- acidosis- ns
- alkilosis- lr
- hyperkalemia- lr

Front 17

ne moa

Back 17

a>b

Front 18

ne effects in sepsis

Back 18

- renal
- inc efferent resistance
- inc urine output and crcl

gi
-dec splanchinric blood flow

Front 19

dopamine effects in sepsis

Back 19

-cardiac
- inc ci
- inc map
-tachy and arrhytmic

renal
- dnt use low dose dopamine
-dnt use for renal perfusion

gi
-inc splanchnic blood flow

Front 20

moa of dopamine

Back 20

<3 mcg/kg/min (low dose)
- d1 receptor agonist
- vasodilation or renal mesenteric

3-10 (med dose)
- beta receptor agonist
- inc cardiac contractility and hr

10-20 (high dose)
alpha receptor agonist
- inc arterial vasoconstriction

Front 21

epinephrine moa

Back 21

b>a

Front 22

epinephrine effects in sepsis

Back 22

-vascular
-inc systemic vascular resis

cardiac
- inc map
-tachy

-gi
-dec splanic blood flow
-inc lactate concentrations

Front 23

phenyl moa

Back 23

alpha receptor agonist

Front 24

phenyl effects in sepsis

Back 24

-vascular
- inc vascular resis (significant)

cardiac
- bradycardia

Front 25

phenyl should be used in what pts

Back 25

tachy

Front 26

vasopressor adr

Back 26

- arrhytmia and tachy
- digital ischemia
- dec gi perfusion (ne and epi)
- dec renal perfusion (low dose dop)

Front 27

use dopamine for pts

Back 27

low ejection fraction

Front 28

ionotrope tx
when do you give prbc

Back 28

hematocrit >30
hg <10

Front 29

dobutamine moa

Back 29

b1 >b2

Front 30

dobutamine effects in sepsis

Back 30

cardiac effects

Front 31

dobutamine vs milrinone which cz more hypotension

Back 31

milnarone

Front 32

milrinone moa

Back 32

phosphodiesterase type III inhibitor

Front 33

all ionotropes are proarrthymic t/f

Back 33

true

Front 34

inotropic ae

Back 34

-tachy
- arrhytmia
-inc o2 consumption : inc risk of mi

Front 35

when should u use dobutamine

Back 35

- septic shock & myocardial dysfxn

Front 36

moa of vasopressin

Back 36

- vasopressin 1 & 2 agonists
- v2 mediate the antidiurtiec response
-v1 mediate vasoconstriction and adrenocorticotropin

Front 37

vasopressin dose is

Back 37

0.03 units/ min

Front 38

vasopressin effects in septic shock

Back 38

vascular: inc bp and dec cathecolamine
gi: dec splanchnic perfusion
high dose of vasopressin has been associated w/ cardiac, digital, splanhic ishcemia

Front 39

analgesic agents

Back 39

-fentanyl
-hydromorphone
-morphine

Front 40

sedative agents

Back 40

-lorazapam
-midazolam
-propofol
-dexemdetomidine

Front 41

analgesic agents

most rapid and shortest duration of action

Back 41

fentanyl

Front 42

analgesic agents

long duration of action

Back 42

morphine

Front 43

analgesic agents
no active metabolites

Back 43

fentanyl

Front 44

analgesic agents

active metabolites

Back 44

- hydromorphone
-morphine

Front 45

analgesic agents

histamine release

Back 45

morphine (most)
hydromorphone (<Morphine)

Front 46

analgesic agents

no histamine release

Back 46

fentanyl

Front 47

sedative agents

lorazepam high dose se

Back 47

> 8 mg/hr solvent related toxicity due to prolong and high infusion dose

Front 48

sedative agents

active metabolite
no active metabolite

Back 48

active= midazolam
not active= lorazepam

Front 49

sedative agents

fast onset of action

Back 49

midazolam

Front 50

sedative agents

midazolam vs lorazepam

Back 50

-mid has active metabolite but no solvent related toxicity

Front 51

propofol se

Back 51

- high tg>500, inc risk of pancreatitis
- propoful infusion syndrome

Front 52

propofol infusion syndrome is cz when you administer doses of

Back 52

>50 mcg/kg/min or a prolong period of time >48 h

Front 53

sedative agents

rapid admin of dexmedetomidine cz

Back 53

hypertension

Front 54

dexmedetomidine is not used much bc

Back 54

expensive

Front 55

when do you give neuromuscular blockades

Back 55

-mechanically ventilated pts
- head trauma pts

Front 56

se of succinylcholine

Back 56

- no gag reflex bc K efflux out of cell
- avoid use in hyerK, rhabdomyolysis, thermal injurty
-fasiculating muscles

Front 57

nm blockage

agents that release histamine
agents that dont release histamine

Back 57

- atracurium,

dont: cistracurium

Front 58

pancuronium se

Back 58

- long lactive effects 90 mins
- vagolytic effect: inc hr >10b/min
- prolong nm blockage in pts w/ renal or hepatic dysfxn

Front 59

vecuronium se

Back 59

- no vagolytic effects
- prolong nm blockage in pts w/ renal or hepatic dysfxn

Front 60

dnt use pancuronium in what pts

Back 60

tachy pts